ArticleJournal of neuroendovascular therapy2026
Bridging Technique with a Stent Retriever for Iatrogenic Internal Carotid Artery Occlusion during Coil Embolization of a Ruptured Aneurysm.
Article in Journal of neuroendovascular therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Iatrogenic arterial dissection is a rare complication in neuroendovascular procedures, with an incidence of 0.15%-0.4% in the cervical carotid artery. In ruptured aneurysm cases, preoperative antiplatelet therapy is usually not administered, and immediate carotid artery stenting (CAS) in the event of occlusive dissection may lead to thrombosis. Even when antiplatelet drugs are administered urgently, their delayed onset may lead to in-stent thrombosis, resulting in cerebral ischemia. We report a case of intraoperative iatrogenic internal carotid artery (ICA) occlusion during coil embolization for a ruptured aneurysm, successfully managed by temporary flow restoration using a stent retriever until antiplatelet efficacy was achieved. Case Presentation: A 51-year-old woman presented with diffuse subarachnoid hemorrhage caused by rupture of a left internal carotid-posterior communicating aneurysm. During coil embolization, dissection of the cervical ICA led to acute occlusion. After nasogastric administration of aspirin (200 mg) and prasugrel (20 mg), a Trevo NXT ProVue Retriever (6 × 37 mm) was deployed to restore antegrade flow. Following confirmation of stable perfusion, a Precise stent (8 × 40 mm) was placed after 1 h. No thrombotic or ischemic events occurred. Postoperative MRI showed no infarction, and the patient was discharged with modified Rankin Scale 0 at 3 weeks. Six-month angiography confirmed complete healing of the dissection and durable patency of the ICA. Conclusion: In ruptured aneurysm cases complicated by intraoperative iatrogenic ICA occlusion, temporary flow restoration using a stent retriever can serve as a safe and effective bridging strategy to prevent ischemia until antiplatelet agents become effective, allowing delayed CAS without thromboembolic complications.
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